Managing lactose intolerance in children
A concerned mom shared her experience with other mothers about the likely causes of diarrhoea in children:
“When my daughter was two months old,
she started having diarrhoea. I let this go on for a couple of days and
then took her to our family doctor. The doctor told me that she has
gastroenteritis (infectious diarrhoea). I was given oral re-hydration
solution and Flagyl syrup.
After a couple of days, she still wasn’t
any better and I was at my breaking point. So, I scheduled an
appointment with another doctor in order to get a second opinion. The
new doctor that I now call my daughter’s pediatrician said that she
didn’t think that the baby has gastroenteritis. She said that she was
likely to be lactose intolerant and had colic.
She told us that when a baby is
developing intolerance to cow’s milk, a symptom of that is diarrhoea.
So, she advised us to change her baby formula, and, immediately, the
diarrhoea stopped.”
Lactose (milk) intolerance happens when
the body cannot break down a sugar called lactose, which is present in
all milk — from breast milk, to dairy (cow) milk and other dairy
products.
Lactose makes up around seven per cent
of breast milk, similar to the amount in infant formula. Lactose
provides around 40 per cent of baby’s energy needs, helps absorb calcium
and iron, and helps ensure healthy development.
Usually, the enzyme lactase, which is
produced in the small intestine, changes the lactose into glucose and
galactose — sugars that are more easily absorbed. Sometimes, babies
don’t produce enough lactase to break down all the lactose, so the
unabsorbed lactose passes through the intestine without being digested.
Undigested lactose irritates the intestine and causes a build-up of wind
and diarrhoea.
Most children or adults who are
diagnosed with lactose intolerance can digest small amounts of lactose,
which would not cause symptoms.
Causes
Primary lactose intolerance happens when
babies are born with no lactase enzymes at all. This is genetic and
extremely rare. It is a medical emergency and the baby would need a
special diet from soon after birth in order to thrive.
Secondary lactose intolerance can occur
if a child’s digestive system is disrupted by illness affecting healthy
production of enzymes like lactase; or if there is not enough lactase
being produced. Illnesses that might lead to secondary lactose
intolerance include tummy bugs that cause gastroenteritis.
Sometimes, lactose intolerance is
confused with other digestive problems, such as food allergy or lactose
overload. This is because these conditions have similar symptoms. Food
allergies and lactose overload are not the same as lactose intolerance,
and do not affect a baby’s production of lactase.
Lactose overload
Lactose overload also causes all the
symptoms similar to lactose intolerance, but it is not the same as
lactose intolerance. Lactose overload occurs when a baby consumes large
amounts of lactose at one time and cannot break it all down. The
condition can occur when bottle-fed babies drink a lot of milk. Again,
babies who are being weaned on too much milk may have conditions
similar. Mothers have a natural oversupply of breast milk in their
baby’s early weeks.
Symptoms
The symptoms of lactose intolerance and
lactose overload are similar and are listed below: pain, wind, swelling
of the tummy, crankiness, failure to settle at feeding times, coming on
and off the breast, failure to gain weight, diarrhoea, frothy green
stools, perianal excoriation (redness and peeling of the buttocks) and
an irritable baby who may pass wind often. Lactose intolerance doesn’t
cause vomiting, but food allergies do.
Diagnosing lactose intolerance
Clinitest tablet: This is usually
deployed when a small amount of stool is mixed with water, and then a
special tablet is added and checked for colour change. This is mostly
used when temporary lactose intolerance is suspected after
gastroenteritis.
Hydrogen breath test: This is used to
test the amount of hydrogen gas in the child’s breath.
Lactose-intolerant children will have higher levels of hydrogen in their
breath, because of the process of fermentation in the gut (when
bacteria feed on the lactose that hasn’t been broken down).
Elimination diet: This involves removing
foods containing lactose from the child’s diet to see whether symptoms
improve. If the symptoms come back once the foods are reintroduced,
lactose intolerance is most likely the cause of the problem.
Stool PH/acidity test: This test, used
in infants and young children, measures the amount of acid in the stool.
It will reveal the presence or otherwise of lactic acid and glucose
produced by undigested lactose and other substances.
Treatment
Treatment for lactose intolerance
depends on the cause. Primary lactose intolerance is an emergency. It
requires the attention of a doctor, pediatrician or nutritionist.
For secondary lactose intolerance caused
by gastroenteritis, using Lactaid drops that contain the enzyme lactase
may help. This is not readily available in Nigeria, though.
Alternate breastfeeding with
lactose-free or soy-based infant formula, which are readily available in
Nigeria. For serious condition, the baby may be weaned from the formula
for a while.
In the case of perianal excoriation, the
redness, cuts or abrasions on the baby’s buttocks due to acidity of the
lactose may be treated with good protective cream.
culled from Punch
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